Urinary Stents: Current State and Future Perspectives

✍ Scribed by Federico Soria

• Tongue: English
• Leaves: 450
• Category: Library

✦ Table of Contents

Preface
Acknowledgments
Contents
Present and Future of Urinary Stents
1 Introduction
2 ENIUS Network
3 Conclusions
References
Indications, Complications and Side Effects of Ureteral Stents
1 Indications of Polymeric Double J Stents
1.1 Prophylactic Indications
1.1.1 Stone Interventional Treatment
1.1.2 Renal Transplantation
1.1.3 Reconstructive Surgery of the Upper Urinary Tract
1.1.4 Non-urological Procedures Involving Ureteral Dissection
1.2 Therapeutic Indications
1.2.1 Decompression of an Obstructed Collecting System
1.2.2 Conservative Treatment of Upper Urinary Tract Trauma
2 Ureteral Stents Complications
2.1 Intraoperative
2.1.1 Failure of Endoscopic Ureteral Stenting
2.1.2 Ureteral Erosion or Perforation
2.1.3 Stent Malposition
2.2 Early Complications (2–4 Weeks)
2.2.1 Stent Discomfort
2.2.2 Vesicoureteral Reflux
2.2.3 Ureteral Smooth Muscle Spasm
2.2.4 Lower Urinary Tract Symptoms
2.3 Late Complications (>2–4 Weeks)
2.3.1 Urinary Tract Infection (UTI)
2.3.2 Stent Migration
2.3.3 Fragmentation and Breakage
2.3.4 Forgotten Double-J Stent and Encrustation
2.3.5 Ureteral Stent Obstruction
References
Indications, Complications and Side Effects of Metallic Ureteral Stents
1 Introduction
2 Indications for Metallic Ureteral Stents
3 Complications and Side Effects of Metallic Ureteral Stents
3.1 Off Label Use of Bare Metal Stents (BMS) Designed for Vascular or Gastroenterological Use in Ureteric Obstruction
3.2 Off Label Use of Covered Metal Stents (CMS) Designed for Vascular or Gastroenterological Use in Ureteral Obstruction
3.3 Covered Metal Stents Designed for Use in Urinary Tract
3.4 Memokath 051™ (PNN Medical A/S, Kvistgaard, Denmark)
3.5 Resonance™ (Cook Medical, Bloomington, IN, USA)
4 Conclusion and Further Recommendations
References
Urethral Stents. Indications, Complications and Adverse Effects
1 Introduction
2 Brief History of Lower Urinary Stents
3 Classification of Stents
4 Aim of This Chapter
5 Materials and Methods
5.1 Literature Search
5.2 Study Selection
6 Results
6.1 Prostatic Stents
6.2 Stents in Both Prostatic and Urethral Region
6.3 Urethral Stents
7 Discussion
8 Limitations and Risk of Bias
9 Conclusion and Future Perspectives
References
Ureteral Stents. Impact on Patient’s Quality of Life
1 Introduction
2 Symptoms Related to Ureteral Stents
2.1 Lower Urinary Tract
2.2 Pain
2.3 Urinary Tract Infection
3 Assessment of the Quality of Life of Patients with Urinary Stents
3.1 Impact on Quality of Life in Patients of Ureteral Stent
4 Innovations for the Improvement of Stented Patients Quality of Life
References
Strategies to Improve the Quality of Life of Stented Patients
1 Introduction
2 Indications of Double-J Stenting
2.1 Urgent Indications
3 Non-urgent Indications
3.1 Shockwave Lithotripsy (SWL)
3.2 Ureterrenoscopy (URS) and Retrograde Intra-renal Surgery (RIRS)
3.3 Pre-operative Stenting
3.4 Post-operative Stenting
4 Stent Timing
5 Stent Materials and Symptoms
5.1 Soft Vs. Hard Stents
6 Ureteral Stent Position and Its Relation to Symptoms
6.1 Ureteral Stent Placement Techniques
7 Ureteral Length Measurement
7.1 Ureteral Length Measurement by Body Shape
7.2 Ureteral Length Measurement by Computed Tomography and Intravenous Urography
7.3 Endoscopic Ureteral Length Measurement
8 Conclusions
References
Use of Drugs to Reduce the Morbidity of Ureteral Stents
1 Introduction
2 Reasons for Stent Related Symptoms (SRS)
2.1 Role of Alpha-1 Blockers/Antagonists
2.1.1 Silodosin
2.1.2 Tamsulosin
2.1.3 Alfuzosin
2.1.4 Naftopidil
2.2 Role of Antimuscarinics/Anticholinergics
2.2.1 Solifenacin and Tolterodine
2.3 Post Ganglionic Blockers
2.3.1 Oxybutynin
2.3.2 Trospium Chloride
2.4 Beta-3 Agonists
2.4.1 Mirabegron
2.5 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
2.6 Phosphodiesterase 5-Inhibitors (PDE5I)
2.6.1 Tadalafil
3 Miscellaneous
3.1 Botulinum Toxin
3.2 Pregabalin
3.3 Calcium Channel Blockers (CCB)
4 Evidence Regarding Combination Therapy
4.1 Alpha-Blocker and Anti-muscarinics/Anticholinergics Combination
5 Complementary and Alternative Medications (CAM)
5.1 Chinese Herbal Medicines
5.2 Capsaicin
5.3 Pumpkin Seed Extract
5.4 Homeopathic Options
6 Conclusions
References
Ureteral Stent Designs to Reduce Stent-Related Symptoms and Improve Patient Quality of Life
1 Introduction
2 Antireflux Membranes and Valves
3 Distal End Modifications
4 Intraureteral Stents
5 Modifications of the Core Architecture of a DJS
6 Dual-Lumen Ureteral Stents
7 Conclusions
References
Encrustation in Urinary Stents
1 Introduction
1.1 Bacteria and Biofilm Formation
1.2 Physicochemical Aspects of Urinary Stents Encrustation and Stone Formation
2 Risks Factors and Complications
2.1 Risks Factors and Complications of Urinary Stone Formation
2.2 Risk Factors and Complications of Encrustations on Stents and Catheters
3 Preventive Strategy of Encrustations and Biofilm Formation
4 Current Methods for Reducing Encrustation and Biofilm Formation
5 Current Methods for the Examination of Encrustation and Biofilm on Urinary Stents
6 Conclusions
References
Forgotten Ureteral Stent Syndrome
1 Introduction
2 Risk Factors for Forgotten Ureteral Stent Syndrome
3 Pathophysiology of the Forgotten Ureteral Stent
4 Symptoms and Complications Associated with the Forgotten Ureteral Stent
4.1 Flank Pain
4.2 Urinary Tract Infections
4.3 Problems in Removal of Ureteral Stent
4.4 Irritation and Tissue Injury
4.5 Renal Failure
5 Diagnosis of Forgotten/Encrusted Ureteral Stent
6 Preventive Strategies for Forgotten Ureteral Stent
6.1 Health Education
6.2 Surveillance and Monitoring Systems
6.3 Simple Removal System
6.4 Innovation in Stents
6.4.1 Use of Stents with Coatings of Different Materials
6.4.2 Anti-reflux Stents [17, 30, 32]
6.4.3 Use of New Technologies in the Prevention of Forgotten Ureteral Stent Syndrome
7 Conclusions
References
Endourological Management of Encrusted Ureteral Stents
1 Introduction
2 Risk Factors
3 Clinical Assessment and Treatment Planning
4 Minimally Invasive Approaches
5 Cystolithotripsy and Cystolitholapaxy
6 Shockwave Lithotripsy (SWL)
7 Ureteroscopy
8 Percutaneous Nephrolithotomy (PCNL)
9 Open Approach
10 Encrusted Nephrostomy Tube
11 Prevention
12 Conclusion
References
Pediatric Ureteral Stents
1 Introduction
2 Classification of Stents
3 Indications of Upper Tract Drainage
4 Techniques of Ureteral Stenting
4.1 Insertion Approach
4.2 Retrograde Stenting
4.3 Antegrade Stenting
5 Calculation of Stent Length
6 The Current Problems and Limitations
7 Future Directions
References
Flow Dynamics in Stented Ureter
1 Introduction
2 Fundamental Characteristics of the Stented Ureter for Modelling Purposes
3 Reduced Models
4 Computational Methods
5 Experimental Methods
5.1 Bacterial Growth
5.2 Drainage Capabilities
5.3 Interplay Between Fluid Mechanics and Encrustation
6 Conclusion
References
Methodology for the Development and Validation of New Stent Designs: In Vitro and In Vivo Models
1 In-Vitro Encrustation Models: A Critical Review
2 Preclinical In Vivo Evaluation of Urinary Stents
2.1 Porcine Model
2.2 Canine Model
2.3 Rat Model
2.4 Rabbit Model
3 Guidelines for Animal Research
References
Methodology on Clinical Evaluation of Urinary Stents
1 Introduction
2 Background
3 Clinical Evaluation in Urinary Stents Improvement
4 Design of Clinical Investigation(s)
5 Population Selection in Clinical Investigations
6 Duration of the Clinical Investigation
7 Analysis of Quality of Life (QoL)
8 Development of Urinary Stent Related Health (UriSteRH) Questionnaire
9 Methodology for Creating New Urinary Stent Related Health (UriSteRH) Questionnaire
10 Validation of UriSteRH Questionnaire
11 Post-Market Follow Up
12 Discussion and Elaboration
13 Conclusion
References
A Dynamically Degradable Surface: Can We ‘Fool’ Bacteria to Delay Biofouling in Urinary Stents?
1 Introduction
2 The Surface, Biofilms and Response to Antibiotics
3 Biofouling of Ureteral Stents
4 Resisting Biofouling of Ureteral Stents: Current and Emerging Approaches
5 A Dynamically Degradable Surface
6 Conclusions
References
Biomaterials for Ureteral Stents: Advances and Future Perspectives
1 Introduction
2 Materials for Ureteral Stents
2.1 Polymeric Materials
2.2 Metallic Materials
2.3 Biodegradable Materials
3 Conclusions and Future Perspectives
References
Coatings for Urinary Stents: Current State and Future Directions
1 Introduction
2 Anti-adhesive Coatings
2.1 Hydrophilic and Hydrophobic Coatings
2.2 Diamond-Like Carbon Coatings
2.3 Topographical Modifications
2.4 Polymer Brushes
2.5 Quorum-Sensing-Based Coatings
3 Bactericidal Coating
3.1 Release of Antimicrobial Agents
3.1.1 Antibiotics
3.1.2 Metal-Based Coatings
3.2 Contact-Killing
3.2.1 Antimicrobial Peptides (AMPs)
3.2.2 Enzyme-Containing Coatings
3.2.3 Bacteriophages
4 Conclusions and Future Perspectives
References
Bacterial Adhesion and Biofilm Formation: Hydrodynamics Effects
1 Introduction
2 Robbins Device and Modifications
3 Flow Chamber
4 Microfluidic Devices
5 Operating Conditions
6 Strengths and Limitations of Flow Platforms
7 Conclusions
References
Biomaterial-Associated Infection: Pathogenesis and Prevention
1 The Clinical Problem
1.1 Biofilms
1.2 Tissue Colonization
1.3 Intracellular Survival
1.4 Antimicrobial Resistance
2 Preventive Strategies
2.1 Anti-adhesive
2.2 Antibiotics
2.3 Antiseptics
2.4 Antimicrobial Peptides
3 Conclusions and Future Perspective
References
Antibiotic-Free Solutions for the Development of Biofilm Prevention Coatings
1 Introduction
2 Natural Polymer Coatings
3 Metal Alternatives
4 Chlorhexidine
5 Triclosan
6 Antimicrobial Peptides
7 Nitric Oxide
8 Quorum-Sensing Disrupters
9 Extracellular Matrix Degrading Enzymes
10 Bacteriophages
11 Conclusions
References
Plasma Based Approaches for Deposition and Grafting of Antimicrobial Agents to Polymer Surfaces
1 Introduction
2 Physical Plasma and Plasma Processes
3 Plasma Approaches to Antimicrobial Surfaces Development
3.1 Deposition of Antimicrobial Plasma Coatings
3.2 Plasma-Based Surface Functionalization and Antimicrobial Agents’ Immobilization
4 Concluding Remarks
References
Antimicrobial Biosurfactants Towards the Inhibition of Biofilm Formation
1 Introduction
2 Sophorolipids and Rhamnolipids Antimicrobial Activity
2.1 Sophorolipids
2.2 Rhamnolipids
3 Fighting Biofilm Formation with Biosurfactants
4 Conclusion
References
Novel Antimicrobial Strategies to Combat Biomaterial Infections
1 Introduction
2 State of the Art
3 Mechanism of Antibacterial Activity CQDs and Their Hybrids
4 Conclusion
References
Light-Activated Polymer Nanocomposites Doped with a New Type of Carbon Quantum Dots for Antibacterial Applications
1 Introduction
2 Antibacterial Effect of CQDs
2.1 Pure CQDs
2.2 Doped CQDs
3 Antibacterial Effect of CQD Polymer Composites
4 Conclusion
References
Nanoparticles. Potential for Use to Prevent Infections
1 Introduction
2 Polymeric Nanoparticles
2.1 Naturally Derived Antimicrobials
3 Non-metallic Nanoparticles
3.1 Metal-Based Nanoparticles
4 Conclusion
References
Urinary Tract Infections and Encrustation in Urinary Stents
1 Introduction
2 The Complex Interaction Between Bacteria, Biofilm and Urinary Tract Infections
3 Encrustation
4 Risk Factors for Encrustation
5 Strategies to Avoid Stent Encrustation
5.1 Stent Coating
5.2 Metal Stents
5.3 Biodegradable Stents
6 Conclusions
References
Learning from Our Mistakes: Applying Vascular Stent Technologies to the Urinary Tract
1 Introduction
2 Vascular Tract vs. Urinary Tract
3 Conclusions
References
Biodegradable Urinary Stents
1 Introduction
2 Ideal Biodegradable Urinary Stent
3 Biodegradables Biomaterials
3.1 Natural Biomaterials
3.2 Synthetic Biodegradable Biomaterials
3.3 Metallic Biodegradable Biomaterials
4 Biodegradable Ureteral Stent
5 Biodegradable Urethral Stent
6 Conclusions
References
New Double-J Stent Design for Preventing/Reducing Irritative Bladder Symptoms and Flank Pain
1 Introduction
2 Are There Any Solutions?
2.1 Accurate Measurement of the Ureter
2.2 Making Positioning Adjustment of the Bladder-End of the Stent
2.3 Creating a Simple Anti-Reflux Mechanism
2.4 Making Changes at the Bladder-End to Allow Its Easy Un-Curling and Re-Curling for Keeping the Stent Body in the Ureter
3 The Way the New JJ Will Work
3.1 Expected Advantages of the New Ureter JJ Stent
References
Drug Eluting Devices in the Urinary Tract
1 Background
2 Drug Eluting Devices
2.1 DES Delivering Antibiotics
2.1.1 Triclosan
2.1.2 Quinolones
2.1.3 Silver and Nitrofurazone
2.1.4 RNA-Inhibiting Peptides and Teicoplanin
2.1.5 Heparin
2.2 DES Delivering Anti-Inflammatory Substances
2.2.1 Ketorolac
2.2.2 Indomethacin, Dexamethasone and Simvastatin
2.2.3 EW-7197
2.2.4 Halofungione (HF)
2.3 DES and DCB Containing Anti-Cancer Drugs
2.3.1 Paclitaxel
References
Methods and Materials for Drug Eluting Urinary Stents Design and Fabrication
1 Introduction
2 Conventional Urinary Stents
2.1 Urinary Stent Materials
2.2 Conventional Stent Manufacturing
3 Drug Eluting Stents
3.1 Coating Strategies
3.2 DES Direct Manufacturing
3.3 DES Bioabsorbable Urinary Stents
4 Conclusions
References
Preventing Biofilm Formation and Encrustation on Urinary Implants: (Bio)coatings and Tissue Engineering
1 Introduction
1.1 Antibody Coating
2 Enzyme Coating
3 Biomimetic Stents
4 Bioactive Nanocoating
5 Tissue Engineering and Regenerative Medicine as Future Research Lines
6 Conclusions
References
Preventing Biofilm Formation and Encrustation on Urinary Implants: (Bio)molecular and Physical Research Approaches
1 Introduction
2 Biodegradable Metal Stents
3 Molecular and Biological Approaches to Prevent Biofilm Formation and Encrustation
3.1 Antisense Molecules
3.2 Non-Pathogenic Bacteria
3.3 Bacteriophages
4 Physical Strategies to Prevent Biofilm Formation and Encrustation
4.1 Electrical Charges
4.2 Enhancing and Maintaining Ureteral Peristalsis
4.3 Ultrasound Waves
4.4 Biosensors
5 Conclusions
References
Ten Steps to Strategic Planning for the Urinary Stents of the Future
1 Introduction
2 Understanding the Side Effects and Complications Related to Urinary Stents
3 Proper Indication for the Use of Urinary Stents
4 Biomaterials
5 Coatings
6 New Designs
7 Biodegradable Stents (BUS)
8 Drug Eluting Stents (DES)
9 Urine and Infection
10 Drugs to Change the Composition of Urine
11 Receptor-Based Stents and Tissue Engineering
References